An internally validated prediction model for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women

• DOI: 10.1016/j.ajog.2021.09.024
• Publication Date: 2021-09-27T04:46:42Z
• Authors: Erkan Kalafat; Smriti Prasad; Pinar Birol; Arzu Bilge Tekin; Atilla Kunt; Carolina Di Fabrizio; Cengiz Alatas; Ebru Celik; Helin Bagci; Julia Binder; Kirsty Le Doare; Laura A. Magee; Memis Ali Mutlu; Murat Yassa; Niyazi Tug; Orhan Sahin; Panagiotis Krokos; Pat O’brien; Peter von Dadelszen; Pilar Palmrich; George Papaioannou; Reyhan Ayaz; Shamez N. Ladhani; Sophia Kalantaridou; Veli Mihmanli; Asma Khalil
• Keywords: 2. Zero hunger; SARS-CoV-2; Pregnancy Outcome; 610; COVID-19; prediction; calibration; vaccination; 3. Good health; 618; Intensive Care Units; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; risk estimation; Humans; Female; pregnancy; Pregnant Women; Pregnancy Complications, Infectious; Original Research; Retrospective Studies

Pregnant women are at an increased risk of mortality and morbidity owing to COVID-19. Many studies have reported on the association COVID-19 with pregnancy-specific adverse outcomes, but prediction models utilizing large cohorts pregnant still lacking for estimating maternal other events.The main aim this study was develop a model quantify progression critical intensive care unit admission in symptomatic infection.This multicenter retrospective cohort including 8 hospitals from 4 countries (the United Kingdom, Austria, Greece, Turkey). The data extraction February 2020 until May 2021. Included were consecutive early postpartum (within 10 days birth); reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. primary outcome illness requiring care. secondary outcomes included death, preeclampsia, stillbirth. between 12 candidate predictors having known severe pregnancy analyzed log-binomial mixed-effects regression as adjusted ratios. All potential evaluated 1 only baseline factors another. predictive accuracy assessed by area under receiver operating characteristic curves.Of 793 who positive symptomatic, 44 (5.5%) admitted care, whom died (1.3%). 'mini-COvid Maternal Intensive Therapy' following demographic clinical variables available disease onset: age (adjusted ratio, 1.45; 95% confidence interval, 1.07-1.95; P=.015); body mass index 1.34; 1.06-1.66; P=.010); diagnosis third trimester 3.64; 1.78-8.46; P=.001). optimism-adjusted curve 0.73. 'full-COvid 1.39; P=.015), lower respiratory symptoms 5.11; 1.81-21.4; P=.007), neutrophil lymphocyte ratio 1.62; 1.36-1.89; P<.001); serum C-reactive protein 1.30; 1.15-1.44; P<.001), 0.85. Neither showed signs poor fit. Categorization high-risk either associated shorter interval (log-rank test P<.001, both), higher death (5.2% vs 0.2%; preeclampsia (5.7% 1.0%; P<.001). A spreadsheet calculator is estimation.At presentation COVID-19, recently can be stratified into high- low-risk disease, even where resources limited. This support nature place These also highlight independent obesity should further emphasize that absence comorbidities, vaccination particularly important these women. Finally, provides useful information policy makers when prioritizing national programs quickly protect those highest fatal